Precise knowledge of the Femoral Head (FH) arterial supply is critical to avoid FH avascular necrosis following open and arthroscopic intra-capsular surgical procedures about the hip. The Medial Femoral Circumflex Artery (MFCA) provides the primary FH vascular contribution. Distribution of vascular foramina at the Femoral Head-Neck Junction (FHNJ) has been reported previously using an imaginary clock face. However, no quantitative information exists on the precise Capsular Insertion (CI) and intra-capsular course of the MFCA Terminal Branches (TBs) supplying the FH. This study seeks to determine the precise anatomic location of the MFCA's TBs supplying the FH, in order to help avoid iatrogenic vascular damage during surgical intervention. In 14 fresh-frozen cadaveric hips (9 left and 5 right), we cannulated the MFCA and injected a polyurethane compound. Using a posterior approach, careful dissection of the MFCA allowed us to identify and document the extra- and intra-capsular course of the TBs penetrating the FHNJ and supplying the FH. An H-type capsulotomy provided joint access while preserving the intracapsular Retinaculum of Weitbrecht (RW), followed by circumferential capsulotomy at the acetabular margin exposing the FH. The dome of the FH was osteotomized 5 mm proximal to the Articular Border (AB) providing a flat surface for our 360° scale. Right-side equivalents were used for data processing.Introduction
Methods
The debate regarding the importance of preserving the blood supply to the femoral head (FH) and neck during hip resurfacing arthroplasty (HRA) is ongoing. Several surgeons continue to advocate for the preservation of the blood supply to the resurfaced heads for both the current HRA techniques and more biologic approaches for FH resurfacing. Despite alternative blood-preserving approaches for HRA, many surgeons continue to use the posterior approach (PA) due to personal preference and comfort. It is commonly accepted that the PA inevitably damages the deep branch of the medial femoral circumflex artery (MFCA). This study seeks to evaluate and measure the anatomical course of the ascending and deep branch of the MFCA to better describe the area in danger during the posterior approach. In 20 fresh-frozen cadaveric hips, we cannulated the MFCA and injected a urethane compound. The Kocher-Langenbeck approach was used in all specimens. The deep branch of the MFCA was identified at the proximal border of the QF and measurements were taken. The QF was incised medially and elevated laterally, maintaining the relationship of the ascending branch and QF, and distances from the lesser trochanter were measured. The deep branch was dissected and followed to its capsular insertion to assess the course and relation to the obturatur externus (OE) tendon and the conjoint tendon (CT) of the short external rotators.Introduction
Methods
